Sex Workers and HIV/AIDS

Although HIV and AIDS affect all people throughout Indian society, sex workers are viewed as prime transmitters of the virus. A recent multinational Independent Commission on AIDS in Asia argued, "policies outlawing sex work are undermining HIV/AIDS prevention efforts by fragmenting and stigmatizing the sex workers and turning condom possession into an act that could lead to jail time."

Organized by UNAIDS, the United Nation’s Population Fund UNFPA and APNSW, the Independent Commission on AIDS in Asia was the first (hopefully not the last) time such powerful multinational institutions tackled the problem in the region. UN staff and government officials representing eight countries gathered in Bangkok, Thailand, to discuss and research the problem of AIDS in Asia.

As a part of their research, the commissioners joined sex workers in Pattaya, a town near Bangkok, to hear first-hand experiences and look at ways to review policies and laws that keep sex workers from accessing HIV services.

Stigmatizing Only Drives Sex Workers Underground"National AIDS programs in Asia often fail to prioritize those most of risk of infection and need to work on more targeted HIV prevention schemes to stop the disease from spreading," said Rueters AlertNet, regional director of the UN agency in charge of HIV/AIDS prevention.

Regional director of UNAIDS Asia Pacific, Steve Kraus agreed: The technology is there to prevent infections, but punitive laws get in the way."

In Cambodia, for example, the spread of HIV/AIDS will only increase if sex workers are made criminals. An anti-trafficking law passed in 2008 only "broadly criminalized sex work, and sent sex workers into hiding," the commission concluded. When brothels closed, Cambodian sex workers were forced to sell sex in less controlled, and more dangerous spaces.

"UNAIDS is concerned that what little money is being spent on HIV programs for sex workers is being reduced further both internationally and nationally, despite evidence that targeting sex workers is one of the most cost-effective ways of preventing HIV," concluded Reuters reporter Thin Lei Win.

’World’s Oldest Profession’ Never More MarginalizedProstitution has existed for centuries. Many people consider it the oldest profession in the world. However, it has not always been as negatively associated and marginalized as it is today.

In ancient India, prostitution was a legal, respected profession. A history of prostitution highlights the commission’s point that discrimination towards prostitutes is not reasonable, but rather based on an antiquated notion that sex workers do not deserve government protection of their health.

Sex Work in India: How British Saw ItThe perception of sex work as an immoral, illegitimate profession by society allows for the continuation of programs that violate basic human rights.

For centuries, the privileged classes have protected themselves from disease, while most vulnerable communities continue to be ignored and exploited. British colonization of India in the mid-1800s caused an increased demand for sex workers.

In colonial India, local policies were built on multi-cultural ideologies of race, sex and class and created the new commonplace opinion of Indian prostitutes as vectors of disease. The example of sex worker history in colonial India helps us better understand why ending discrimination in India will require laws, education and community outreach efforts to sex workers in order to start to erase the view of sex workers as immoral beings.

After the First War of Indian Independence in 1857, India came under the direct control of the British Crown, and order was maintained by strategically placed military garrisons throughout the new British colony. The new colony status and heavy military control led to a sudden influx of British men into India.

According to author Phillipa Levine, "the presence of an overwhelmingly male colonial population (soldiers and officials, overseers, managers and salesmen, and manual laborers from other parts of the globe) both expanded and altered local sex trades."

British officials viewed sex work as a "necessary evil" that men would always partake in, because of natural male desire. The view of sex workers in India became more complex as well as damaging, when the regulated sexual exploitation of local Indian women was a measure of colonial success.

The discussion of the causes and prevention of sexually transmitted diseases in the British colony of India focused on ideas of sex workers as the transmitters sin as well as disease. In colonial British army garrisons, all cases of sexually transmitted diseases was prevalent.

But it was not the "natural" sexual drive of the soldiers that led to their illness; rather the "promiscuity of native women." According to the British, this disease was be passed from sinners (prostitutes) to "innocents" (men). Levine states.

The colonial Indian government viewed STDS as "a disease which passed from women to men, and from women who were sexually active to men whose level of sexual activity was never scrutinized as closely."

Sex Work in India: After the British RajThe continued over-scrutiny of women’s sexuality continues today. The sex workers in India are mostly made up of the country’s "untouchable" class, the lowest ranking group in the Hindu caste system. These women are marginalized by society, and thus, made more vulnerable to disease.

"One thing I observed immediately in Mumbai was the connection between social vulnerability, class status and HIV," writes Christine D’Adesky in Moving Mountains: The Race to Treat Global AIDS.

The view of sex workers as immoral women keeps them marginalized, lower class persons without access to the resources needed to pull themselves and their families out of a cycle of poverty and disease.

After independence, India began a system of "toleration" under the 1956 Suppression of Immoral Traffic Act (SITA). The act was amended to become The Immoral Traffic of Women and Girls Prevention Act (PITA) in 1986. Much like colonial efforts to regulate prostitution, SITA does little to address the realities of sex work in India.

Under SITA prostitution is defined as: "the act of a female who offers her body for promiscuous sexual intercourse for hire, whether in money or in kind, and whether offered immediately or otherwise, the expression of prostitute will be construed accordingly,"

The amended version of the law, PITA, does not change this definition significantly, but includes more penal provisions for "soliciting, seducing, activity in the vicinity of public places, and brothel keeping." While prostitution is a social problem, it is not one that can be solved by regarding women in the profession as "promiscuous" or criminals.

This approach, as the Independent Commission on AIDS in Asia found, decreases the quality of life for sex workers and increases prevalence of disease in communities.

In this week's Ask the Doc column, Dr. Howard Scheiner takes a realistic look at the latest studies around Pre-Exposure Prophylaxis (PrEP) with Truvada, and lets you know what you'll have to do to keep safe this summer.